MEDICARE: ROOTED YOUTH AND FAMILY THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1932056322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED YOUTH AND FAMILY THERAPY LLC

Provider Business Mailing Address
First Line	:	23350 N 23RD AVE UNIT 8040
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-0031
Country	:	US
Telephone Number	:	619-379-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	23350 N 23RD AVE UNIT 8040
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-0031
Country	:	US
Telephone Number	:	619-379-3111
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	ENRICO LORENSO ROGERS-ATKINS
Credential	:	LCSW
Telephone Number	:	619-379-3111

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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